In May 2006, the Royal College of Psychiatrists published the consensus statement on high-dose antipsychotic medication, highlighting that up to a quarter of psychiatric in-patients are prescribed a high dose of antipsychotic medication (Royal College of Psychiatrists, 2006).
I carried out a cross-sectional survey collecting data on type, doses and combinations of antipsychotic medication used at the regional medium secure unit, general adult psychiatric wards and psychiatric intensive care unit. Data were analysed to calculate the proportion of patients on high-dose antipsychotic medication. Information sources were the prescription kardex and ward-based casenotes. The College's definition of high-dose antipsychotic was used (Royal College of Psychiatrists, 2006).
At the regional medium secure unit, 30% of patients on antipsychotic medication (n=12 out of the total 41) were on high-dose antipsychotics. On general adult wards and psychiatric intensive care unit this number was 6 (17%, n=35 on antipsychotic medication). Of the total study sample on high-dose antipsychotic medication (n=18), polypharmacy was present in 94% of the patients.
This survey shows that patients on forensic wards are almost twice as likely to be prescribed high-dose antipsychotics as those on psychiatric intensive care units and general adult wards. Patients on high-dose antipsychotic medication are not only at risk of increased side-effects but also arrhythmias and sudden death. More needs to be done to change prescribing habits and to encourage evidence-based prescribing.
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